title: Lack of a correlation between portal vein flow and pressure: toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation.
abstract: The portal vein flow (PVF), portal vein pressure (PVP), and hepatic venous pressure gradient (HVPG) were prospectively assessed to explore their relationships and to better define hyperflow and portal hypertension (PHT) during liver transplantation (LT). Eighty-one LT procedures were analyzed. No correlation between PVF and PVP was observed. Increases in the central venous pressure (CVP) were transmitted to the PVP (58%, range = 25%-91%, P = 0.001). Severe PHT (HVPG ≥ 15 mm Hg) showed a significant reciprocal association with high PVF (P = 0.023) and lower graft survival (P = 0.04). According to this initial experience, an HVPG value ≥ 15 mm Hg is a promising tool for the evaluation of hemodynamic stress potentially influencing outcomes. An algorithm for graft inflow modulation based on flows, gradients, and systemic hemodynamics is provided. In conclusion, the evaluation of PHT severity with PVP could be delusive because of the influence of CVP. PVF and PVP do not correlate and should not be used individually to assess hyperflow and PHT during LT.
authors.affiliation: Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Sainz-Barriga
authors.forename: Luigia
authors.initials: L
authors.lastname: Scudeller
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Costa
authors.forename: Bernard
authors.initials: B
authors.lastname: de Hemptinne
authors.forename: Roberto Ivan
authors.initials: RI
authors.lastname: Troisi
mesh_terms: D000368:Aged; D000465:Algorithms; D002496:Central Venous Pressure; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology / Q000628:therapy; D008099:Liver / Q000502:physiology; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology*; D011169:Portal Vein / Q000473:pathology*; D011312:Pressure; D011446:Prospective Studies; D016896:Treatment Outcome